Written by: Dr. Marcy Rosen, M.D., F.A.C.O.G
The well woman exam is one of the most important appointments that gynecologists perform. But with medicine’s tendency to change according to newest evidence and best practices, you may find that your appointment leaves you with some questions. Here are six things that we, as your friendly neighborhood gynecologists, want you know to know about these visits.
1. The Well Woman Exam is an Annual Exam
This means that it should be done once a year. What happens every year may be different according to your age and needs, but you should plan to see your gynecologist annually.
2. The Well Woman Exam covers a lot of ground
The point of a well woman exam is really a “wellness check”, and a “preventative exam”. Our job is to look over your state of health at that moment in time, and identify areas that may already be causing you issues, or things that may cause issues in the future. This includes assessing your vital signs, going over your overall health for the previous year (or your whole life if we are seeing you for the first time), determining any preventative screening tests that you are due for, assessing your hormonal status, evaluating the health of your reproductive system, screening for depression, and asking about any sexual concerns. Then we do a physical exam including a pelvic exam if needed. Generally speaking, these visits are allotted 15 minutes of time in the schedule. Does this sound like not a lot of time? We agree. It’s really important to stress that the point of this visit is to identify areas of concern. Treating these concerns may entail further testing and future visits where we can focus on these areas. We try not to miss the big picture during the annual exam. Which brings me to my next point…
3. If you know you have a concern, don’t wait for the well woman exam to bring it up.
The well woman exam is somewhat of a Super Bowl for women- we will often save up all our issues for this one big appointment. But as you see above, these appointments are more of a screen to help us find areas of concern. If you already know there is a problem, come to us before your well woman exam. We can take the time to focus on this specific concern, and even perform testing and possibly come up with treatments that we can continue to follow through the well woman exam. We generally won’t have time to go into specific treatment or testing options during a well woman exam. If you come with more than one or maybe two small issues you want addressed, we will need to follow them up at a later time. Better to come get them treated early!
4. The well woman exam does not equal a pelvic exam, and a pelvic exam does not equal a PAP smear
I have to admit that we doctors are guilty for interchanging these terms for years. But it’s important for you to know that not every annual appointment requires a pelvic exam, and for you to understand what happens when we “go below” during the physical exam. A pelvic exam includes visualizing the external and internal genitalia, which generally involves the use of a speculum. This may be followed by a bimanual exam, in which one or two fingers are inserted into the vagina and are used to try to feel your internal pelvic structures. Sometimes, we need to press onto your abdomen to help with this part of the exam. Sometimes, a rectal examination is also done. A PAP smear is a swab that removes some cells from the cervix to be sent to a pathologist for testing for abnormal cells. Other swabs (for example, for yeast infections or sexually transmitted infections) can also be taken at this time, with or without the PAP smear. All of these parts of the examination can be performed individually, together, or entirely left out, depending on your individual needs. You can no longer assume that because you had a speculum exam you received a PAP smear. It’s important to make sure you know what is being done, and to convey to your doctor in advance if there is a particular test you would like performed.
5. The guidelines for screening tests may seem new and unfamiliar
Recommendations for when to screen for which disease are always changing. It’s hard sometimes for even doctors to keep up with all the newest guidelines. An example of this is the recent deviation from the annual PAP smear. PAPs can now be performed every 1-5 years, starting at age 21 and ending at age 65, depending on your history and individual needs. People who have been receiving annual PAP smears for years may find this a little unnerving. We will try to remember to explain to you why you receive- or don’t receive- a particular test that year, but always feel free to ask.
6. Focus the visit on yourself
I understand the temptation to try to use your time with your doctor to ask questions or get a second opinion for a friend, relative, etc. You may worry or be curious about your loved one’s health care and just want to get an idea from the doctor you trust most. But as you can see, we have a lot to do in our visit with you. Not only can we not focus a sufficient amount of attention on the person you are asking about, it’s very hard to make adequate medical decisions based upon secondhand information. If we are the doctor of the person you’re asking about, we may not be able to disclose any information due to HIPAA privacy laws, and this may force us into an awkward situation. Just don’t do it. Take this Super Bowl appointment, and get all you can out of it for yourself!
As someone once said, “I prepare for this appointment more than I prepare for most first dates”—make it count!